Re Physican/Nursing crisis: Has Anyone Seen...

the privately-paid one-half hour segment being aired on TV channels in NC about the "crisis" of doctors leaving our state due to high malpractice premiums? I had NO idea the shortage of doctors was at such a crisis level here in NC... and about to get MUCH worse unless there is tort reform.. FAST. It was produced by doctors and IS very disturbing. One of the doctors featured was Dr. Randy Chitwood, head of Cardiothoracic Surgery at PCMH. (No, he did not say he was leaving the state, but just his presence in this documentary was an implied threat... PCMH would be "lost" without Dr. Chitwood )

<the "crisis" of doctors leaving our state due to high malpractice premiums>

Interesting. A doctor shortage may occur because of monetary issues and the nation is jumping to rush in new laws to appease them. A severe nurse shortage exists at the bedsides mainly because of monetary issues - but how many states are rushing in laws just as fast to correct that as they are to correct the doctor's problem?

Feb 29, '04

Vicky/J.T.

Are you unaware of the Reader's Digest articles last year, "The Real Health Care Crisis"? Two articles stated that the real crisis is the "shortage" of Nurses. The "shortage" (35% of licensed nurses are NOT at the bedside) has been addressed by your government as the "Nurse Reinvestment Act." It sends millions to fat-cats of industry to "train" new nurses, (who will spend less than 5 years on the job before leaving), and recruitment of nurses with rediculous "bonus" schemes, instead of empowering nurses to control their work environment.

Scientific studies have consistently shown that if you are in a hospital without a DOCTOR you will die in days. Without a nurse you will die within hours.

Whenever you are admitted to a hospital HALF of your bill is nursing salaries. How is it that so much of your health care dollar is NOT directed by Nurses? The ANA (and the AMA) is in bed with the health care industry. I can tell you from personal experience where the ANA helped to end my nursing career. After 20 years of faithful service, I am currently with no income (for the last 6 months, and no unemployment or health insurance) and may never work as a nurse again.

The only hope on the horizon is the CNA. I may have to re-locate to California to work 5-10 years and retire as a nurse. Why do you suppose the media makes such a big deal about DOCTORS? That's because they have a better union than nurses do. ANA sucks, long live the CNA.

Feb 29, '04

I don't know why everybody thinks moving to California is any better. We have a crisis of our own called, Medi-Cal! Also we have a tremendous amount of people coming from out of state that are so-called, private payers. MDs here are getting "screwed" everyday because they have to take care of patients that have no insurance or money. If they do take care of them the pay is for a procedure is a joke! Example, to put in a CVP-$25. I know of patients who WERE NOT TREATED in the own state and told to go to California where they could get the appropriate treatment. This is why California is in a health crisis, because other states are so CHEAP they won't take care of their own. The hospital where I have worked for 27 years just sent out notices to everyone that "lay-offs" are coming real soon. The reason, we are losing almost ONE MILLION dollars a month due to the un-insured, non-paying patients that come through our ED. Our ED is not the trauma type but more of a clinic type, so if it closed tomorrow no lose. We do have a fairly new County hospital that it seems is always on diversion, so they refuse a lot of transports there. So you can see, California is not the haven that alot of people think. I can see hospitals putting hiring freezes on and only hiring very experienced nurses in the future. I think the CNA will be a help in retaining nurses jobs but can't be expected to guarantee anything. Look at Nevada for an exodous of doctors because of the malpractice issue. I just remembered a neurosurgeon who just retired after many years of practice, the reason for his getting out- $1.5 million dollars a year for his malpractice insurance!!!!!!!! His billing only brought in a little over $900,000 a year, then his overhead and his take home. It was a losing effort on his part. That figure was what he was going to have to pay this year, it was less last year. He is a much happier camper now. Mike

Feb 29, '04

Interesting. A doctor shortage may occur because of monetary issues and the nation is jumping to rush in new laws to appease them.

Actually, there has NOT been a rush for tort reform, since most politicians on both the federal and state level are either lawyers or CONTROLLED by lawyer interests. (Such as our illustrious Senator and Presidential-hopeful John Edwards, who is a PERSONAL INJURY LAWYER... heaven help us if he ever becomes President.) This is why the doctors took their case "directly" to the people.
This documentary was extremely disturbing. Showed how increasingly hard it is to obtain obstetrical services, especially in small isolated NC towns. Some patients are now traveling 2 hours to the nearest delivery room. Emergency rooms overflowing with patients, because they cannot access a primary care physician (very limited doctors taking new patients). Neurosurgeons leaving the state, with one (can't remember his name) leaving Hendersonville because of high malpractice premiums. This same neurosurgeon had just LEFT Philadephia about 1-1/2 years ago due to the same problem there.
Of course it did not mention the nursing shortage, as this is another, wholly separate topic. It also did not mention the crisis a lot of people face who do not have health insurance and go to emergency rooms for that reason. The documentary was written and scripted by doctors.

Mar 1, '04

interesting

Mar 1, '04

Quote from owney

the "shortage" (35% of licensed nurses are not at the bedside) has been addressed by your government as the "nurse reinvestment act." it sends millions to fat-cats of industry to "train" new nurses, (who will spend less than 5 years on the job before leaving), and recruitment of nurses with rediculous "bonus" schemes, instead of empowering nurses to control their work environment.

owney:

have you read the entire act?

pub.l. 107-205 to amend the public health service act with respect to health professions programs regarding the field of nursing.
signed: aug. 1, 2002 textpdf

disagreeing with this point " it sends millions to fat-cats of industry to "train" new nurses, (who will spend less than 5 years on the job before leaving), and recruitment of nurses with rediculous "bonus" schemes, instead of empowering nurses to control their work environment."

many rn's are unaware this law has nurse retention as one of its major components.

see:
what does the nurse reinvestment act mean to you? online journal of issues in nursing. vol. #8, no. #1, manuscript 5. available: www.nursingworld.org/ojin/topic14/tpc14_5.htm
(many of the following points from this article)

title ii. nurse retention
title ii addresses the nursing shortage by emphasizing the role of the work place in retaining and enhancing the education and professional development of nurses.

title ii addresses nurse retention. this component of the nurse reinvestment act represents a significant departure from older versions of nurse training and nursing education laws described in title 8 of the public health service act. typical legislation relied on schools of nursing to address the cyclical nursing shortages, focusing on increasing the supply of nurses, preparing nurses for specified areas of practice, and encouraging work force diversity by the recruitment of minority students. the literature on the current nursing shortage identifies retention as a factor and proclaims that nurses change jobs and careers because of issues in the workplace (aiken et al., 2001). contemporary debate often cites the culture of the hospital workplace as a factor in the shortage. mandatory overtime became the mantra to focus attention on poor working conditions. newspapers reflected the charge that acute care hospitals are not good places for nurses or patients (fackelmann, 2001). on the positive side, the reawakened interest in the work place focused new attention on the value of magnet hospitals (mcclure, poulin, sovie, & wandelt, 1983). these institutions attracted and retained nurses because of the governance style of the organizations and their ability to engage nurses in decision making.

section 201, building career ladders and retaining quality nurses section 831, nurse education, practice, and retention grants:
this section, composed of parts a, b, and c, addresses funding priorities in education, practice and retention. it applies practice and educational frameworks to retention with two categories: (a) nurse education, practice, and retention, and (b)building career ladders and retaining quality nurses.

section 831b. practice priority areas: this section describes the availability of grants to demonstrate new nursing practice arrangements that improve access to primary health care for underserved and high-risk populations and to develop skill in providing managed care and quality improvement in organized health systems.

section 831b introduces new ideas as it gives the secretary authority to award demonstration grants or contracts; to establish/expand practice arrangements in non-institutional settings; to improve access to primary health care in medically underserved communities; to provide care for underserved and high-risk groups, such as the elderly, persons with hiv/aids, substance abusers, the homeless, and victims of domestic violence; to provide managed care, quality improvement, and other skills needed to practice in existing/emerging health care systems; and to develop cultural competencies among nurses

section 831c, retention priority areas: in this section, priority is given to the development of career ladder programs and the design of systems that enhance the delivery of patient care by improving collaboration and communication within the health care team.

section 202, comprehensive geriatric education
this section establishes programs to educate and develop nurses and others to care for the nation's aging.

section 203, nurse faculty loan program
to address the shortage of faculty in schools of nursing, the federal government has created a loan forgiveness program for nurses who prepare to become faculty in the nation's nursing schools. section 846a describes the establishment of the nurse faculty loan program. this section encourages schools of nursing to partner with the federal government in establishing and administering a nurse faculty loan fund. graduates who teach full time in schools of nursing for four years can have eighty-five percent of their school loans canceled

section 204, reports by the general accounting office
the final component of p.l. 107-205 mandates that the comptroller general of the united states prepare a series of comprehensive reports to congress documenting how the educational and practice communities responded to this legislative initiative and describing the effectiveness of the nurse reinvestment act in addressing the nation's nursing shortage.

love this quote from the authors :
if nursing does not come forward and write grants to develop media campaigns, health insurers, managed care organizations, hospitals, and unions will shape nursing's image to suit their ends.

section 831b challenges the nursing community to envision and create practice environments that respond to contemporary and future demands, are more supportive of patients and their families, and create healthier places for nurses to practice their profession.

``(c) retention priority areas.--the secretary may award grants to
and enter into contracts with eligible entities to enhance the nursing
workforce by initiating and maintaining nurse retention programs
pursuant to paragraph (1) or (2).
``(1) grants for career ladder programs.--the secretary may
award grants to and enter into contracts with eligible entities
for programs--
``(a) to promote career advancement for nursing
personnel in a variety of training settings, cross
training or specialty training among diverse population
groups, and the advancement of individuals including to
become professional nurses, advanced education nurses,
licensed practical nurses, certified nurse assistants,
and home health aides; and
``(b) to assist individuals in obtaining education
and training required to enter the nursing profession
and advance within such profession, such as by providing
career counseling and mentoring.
``(2) enhancing patient care delivery systems.--
``(a) grants.--the secretary may award grants to
eligible entities to improve the retention of nurses and
enhance patient care that is directly related to nursing
activities by enhancing collaboration and communication
among nurses and other health care professionals, and
by promoting nurse involvement in the organizational and
clinical decisionmaking processes of a health care
facility.

it's often human nature to take the easy way:

let nursing educators who have established programs in place, apply for grant monies and crank out more students.

monies there for the taking...nurses have to come together & demand that the funds be used for empowering nurses to control their work environment.

gee, that's what the nursing unions are doing now. for those who feel is union unnecessary, and that they can speakup for themsleves, the time is now to take advantage of taking the reigns and controlling our profession.
just don't talk the talk, act on the talk today!

Last edit by NRSKarenRN on Mar 1, '04

Mar 1, '04

responding to vicky:

"the initiative is funded by doctors for medical liability reform, a coalition of 230,000 physicians throughout the country who practice in specialties such as emergency medicine, neurosurgery, obstetrics and gynecology, orthopedics and cardiology -- high-paying niches that also carry high risk and high insurance premiums."

one medical center in my county, was once the star jewel of a healthcare system has:

closed peds then nicu
then closed ob
psych program on shaky grounds.
it's no longer a medical center, but a community hospital.
personally know of 15 physicians who left there
malpractice costs went from 3 million to 21 million in two years.
all due to changing patient population--mostly middle age and elderly medicare with high rate impoverished population, no health insurance or mostly medical assistance. orgnaizations can't survive that sort of payer mix.

five hospitals have closed in philadelphia in past three years. two other competing community hospitals just announced restructuring: one will be acute care, other long term care in order to survive. tenet trying to close mcp.

glad i'm not in management in a hosptial setting in pa these days; must be so gut renching to make these changes.

Mar 1, '04

Terrible. I hope the laws are changed before it is truly too late.

Mar 3, '04

I think we are going to see this situation increase rather than get better over the next few years. *sigh*

Actually, I think virginia voted AGAINST limiting the amount of $$ one can collect in a malpractice suit. And I know my OB already left this state d/t high malpractice premiums.